Provider First Line Business Practice Location Address: 
ELM AND CARLTON ST
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF PHARMACY
    Provider Business Practice Location Address City Name: 
BUFFALO
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
14263-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
716-845-8725
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/05/2013